Speech pathology therapy useful for persistent cough
MedWire News: Review findings suggest that interventions used to treat speech pathology are also effective treatment options for patients with chronic refractory cough.
Indeed, such interventions can reduce cough reflex sensitivity, improve voluntary control of cough, and minimize laryngeal irritation if correctly implemented, say Anne Vertigan and Peter Gibson from John Hunter Hospital in Newcastle, New South Wales, Australia.
They add: "Behavior modification and reframing of cough may also occur following treatment. There may also be an element of the placebo response following therapy, as this is commonly observed in the treatment of cough."
The review includes findings from a study involving 87 patients with chronic cough refractory to standard cough treatment. All were randomly assigned to four sessions of speech pathology intervention or placebo. The intervention involved patient education, teaching of cough control techniques, vocal hygiene training, and psychoeducational counseling. Placebo consisted of lifestyle education and stress management.
At the end of treatment 88% of patients in the intervention group reported improved cough symptoms versus 14% of placebo patients. Specifically, the reduction in mean pre-intervention voice and upper airway symptoms scores achieved after the intervention were at least three times greater among the intervention group than in the placebo group.
The review, published in the journal Lung, also explores the rationale behind the use of practices developed for speech pathology in the treatment of chronic cough patients.
Vertigan and Gibson explain that laryngeal function is not only necessary for speech and swallowing, but also involved in the action of coughing.
Previous studies have illustrated that up to 50% of patients with cough also have laryngeal dysfunction, and that laryngeal activities, such as talking, often trigger the cough reflex, say the authors.
They further explain that patient education and the use of cough control techniques are crucial if a speech pathology intervention is to effectively manage chronic refractory cough. In patients with chronic refractory cough, the aim of therapy is not to prevent triggering the cough reflex, but to suppress the urge to cough when the sensation occurs, add Vertigan and Gibson.
"Speech pathology treatment has been incorporated into the Australian cough guidelines and could be a useful option for patients with chronic cough who have failed medical treatments," the authors conclude.
By Lauretta Ihonor